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Treatment of War Related Psychiatric Injuries Post-World War II

American assault troops of the 16th Infantry Regiment, injured while storming Omaha Beach, wait for evacuation to a field hospital for further medical treatment, June 6, 1944. Treating the invisible wounds of war was more problematic for the armed forces than treating the wounds of the flesh. U.S. Army photo

The Greatest Generation has been feted and honored for its ability to withstand trials and tribulations. It does not follow, however, that the combat veterans of World War II were any more immune to war trauma than veterans of other wars. More than 16 million were deployed during the war years of 1941 to 1945; approximately 4 million served in combat zones. World War II, with over 400,000 American military dead and 670,000 wounded, had a casualty rate second only to the Civil War. Not counted in those figures were the scores of combatants who returned home with invisible psychological wounds of war, even though approximately forty percent of medical discharges during the war were for psychiatric reasons.

The commonly used term “combat fatigue” reflected the prevailing attitude that once a soldier was removed from combat and provided with time for rest and relaxation, his war trauma would disappear. Post Traumatic Stress Disorder (PTSD) was not a clinical diagnosis until 1980, when it was added to the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM III). Prior DSM editions had no specific classification for postwar trauma. Terms like stress response syndrome, gross stress reaction, psychoneurotic disorder, anxiety neurosis, character disorder, and adjustment reaction to adult life were all diagnostic phrases utilized by the Veterans Administration (VA) to describe the World War II combat veterans who applied to the agency for help because they could not leave the war behind.

A U.S. Marine after two days and nights of hell on the beach of Eniwetok in the Marshall Islands, Feb. 1944. His face is grimy with coral dust but the light of battle stays in his eyes. The theory at the time was that combat fatigue could be cured with rest and relaxation. National Archives photo

The prevailing theory to explain war trauma was based on Freudian analysis. This approach posited that the main reason a combat veteran had psychological issues postwar was because feelings of infantile anxiety and hostility were repressed until his underlying neurosis was aroused by war. The horror of combat was not considered to be a major independent cause of psychological problems. The assumption was that the soldier/veteran was already emotionally flawed prior to the war. Since the mental distress was seldom considered service related, the veteran was often not entitled to VA benefits.

World War II veterans who exhibited severe mental and behavioral problems were often institutionalized in Veterans Administration (VA) hospitals. By the 1950s the VA system operated 109 general hospitals and thirty eight neuropsychiatric hospitals. There are estimates that psychiatric cases accounted for half of veterans’ hospitalizations in VA facilities in the fifties, according to the Committee on Veterans Compensation for Posttraumatic Stress Disorder in PTSD Compensation and Military Service.

Commonly used therapies in VA hospitals during early postwar years were shock treatments – insulin and electric. Insulin shock was induced when patients received large doses of insulin over a period of weeks, causing daily comas that supposedly would shock the patient’s system out of mental illness. Electric shock operated on a similar principle of disordering the mind and jolting the veteran out of his emotional distress by electrodes sending electric currents to the brain.

In 1949, the American Journalof Psychiatry published results evaluating the efficacy of these procedures performed during an experimental study on one thousand VA hospitalized veterans. The article noted that social recoveries had been achieved for a large percentage of those diagnosed with psychotic reactions to wartime. Not mentioned in the report were possible side effects of the therapies, including organic brain damage.

The shock treatments were not the most egregious of procedures performed on veterans in the VA system. Lobotomy, or psychosurgery, which consisted of severing the frontal lobes of the brain, was utilized to relieve anxiety and psychological distress. VA research on lobotomized veteran patients was done through a cooperative study process sponsored by the agency. Under this model, VA hospitals applied to be part of a VA Lobotomy Study, consisting of experimental research on psychiatric veteran patients which tested the effectiveness of lobotomy as a treatment. Jack Pressman in his book, Last Resort: Psychosurgery and the Limits of Medicine, estimated that by 1950, prior to the creation of the formal study, 1500 lobotomies had already been performed in VA hospitals. There are no accurate numbers on how many total lobotomies were performed on the hospitalized veteran population.

Various journal articles from the 1950s discussed studies done at VA hospitals in California, Minnesota, New Jersey, New York, Virginia and Tuskegee, Ala., a site where studies were done on African-American veterans. Psychosurgery as a treatment choice began to diminish in the mid to late 50s, after the advent of pharmaceuticals for psychiatric cases. A retrospective study evaluating ten years of lobotomies at VA hospitals was published in 1969 in the Hospital and Community Psychiatry Journal. Patients who had severe emotional tension, assaultiveness, suicidal behavior and unresponsiveness to shock treatments had been subjected to the procedure. It was determined that assaultiveness had lessened, but a significant number of lobotomized patients had intellectual disabilities and seizures. Only ten percent had ever been discharged from the hospital.

Post Traumatic Stress Disorder may not have been an official diagnosis until 35 years after the end of World War II, but many veterans of that war suffered from war related trauma. While the story of the Greatest Generation’s achievements is well known, the invisible wounds of World War II and the ineffective and sometimes inhumane responses to the veterans’ psychiatric distress is a less familiar tale.